title: Factors associated with late specialized rehabilitation among veterans with lower extremity amputation who underwent immediate postoperative rehabilitation.
abstract: OBJECTIVE
  The aim of this study was to determine what patient- and facility-level characteristics drive late specialized rehabilitation among veterans who already received immediate postoperative services.
  
  
  METHODS
  Data were obtained from eight administrative databases for 2,453 patients who underwent lower limb amputation in Veterans Affairs Medical Centers in 2002-2004. A Cox proportional hazards model was used to determine the hazard ratios and 95% confidence intervals of the factors associated with days to readmission for late services after discharge from surgical hospitalization.
  
  
  RESULTS
  There were 2304 patients who received only immediate postoperative services, whereas 152 also received late specialized rehabilitation. After adjustment, veterans who were less disabled physically, residing in the South Central compared with the Southeast region, and had their surgeries in facilities accredited by the Commission on Accreditation of Rehabilitation Facilities were all more likely to receive late services. The hazard ratios for type of immediate postoperative rehabilitation were not constant over time. At hospital discharge, there was no difference in receipt; however, after 3 mos, those who received early specialized rehabilitation were significantly less likely to receive late services.
  
  
  CONCLUSIONS
  The factors associated with late specialized rehabilitation were due mainly to facility-level characteristics and care process variables. Knowledge of these factors may help with decision-making policies regarding units accredited by the Commission on Accreditation of Rehabilitation Facilities.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA.
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.forename: Pui L
authors.initials: PL
authors.lastname: Kwong
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Bates
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Vogel
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
mesh_terms: D000068:Accreditation; D000368:Aged; D000674:Amputees / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D016016:Proportional Hazards Models; D012047:Rehabilitation Centers; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans